{"hospital_name": "Texas Regional Medical Center, LLC", "last_updated_on": "2026-04-01", "version": "3.0.0", "pid": "1549953158", "rid": "9317", "location_name": ["Baylor Scott & White Medical Center - Sunnyvale"], "hospital_address": ["231 S Collins Rd, Sunnyvale, TX 75182"], "type_2_npi": ["1255579389"], "license_information": {"license_number": "100033", "state": "TX"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "#2 FIBERSNARE #2 FIBERWIRE 26\" WH/BLUE AR-7209SNL", "code_information": [{"code": "AR-7209SNL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "00338-0049-11 - Sodium Chloride 0.9% Soln", "code_information": [{"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "1.0MM KWIRE 71161010", "code_information": [{"code": "71161010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.82, "discounted_cash": 116.89, "setting": "both", "billing_class": "facility"}]}, {"description": "1.1MM WIRE WITHOUT STOP", "code_information": [{"code": "91250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "10G IVAS ELITE BALLOON SYSTEM", "code_information": [{"code": "808-015-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10010.0, "discounted_cash": 6006.0, "setting": "both", "billing_class": "facility"}]}, {"description": "11G IVAS ELITE BALLOON KIT", "code_information": [{"code": "808-115-800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5820.0, "discounted_cash": 3492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "12 Lead EKG 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1554967", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 55.73, "maximum": 55.73, "gross_charge": 439.0, "discounted_cash": 263.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 55.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "12 Lead EKG w/o interp 93005", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "1558406", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 55.73, "maximum": 55.73, "gross_charge": 439.0, "discounted_cash": 263.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 55.73, "methodology": "case rate"}], "billing_class": "facility"}, {"minimum": 55.73, "maximum": 55.73, "gross_charge": 470.0, "discounted_cash": 282.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 55.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "14MM CURVED VACUUM CURETTE 616", "code_information": [{"code": "616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2361.0, "discounted_cash": 1416.6, "setting": "both", "billing_class": "facility"}]}, {"description": "180 d implant glucose sensor", "code_information": [{"code": "G0308", "type": "HCPCS"}], "standard_charges": [{"minimum": 1988.0, "maximum": 2209.0, "setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": 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"standard_charge_dollar": 1464.27, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. LOW COST SKIN SUB. 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GRAFT TO TRK/ARM/LEG GREATER THAN OR EQUAL TO 100 SQ CM C5273", "code_information": [{"code": "C5273", "type": "HCPCS"}, {"code": "46003850", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1661.44, "maximum": 7101.0, "gross_charge": 7464.0, "discounted_cash": 4478.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1661.44, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. LOW COST SKIN SUB. GRAFT TO TRK/ARM/LEG GREATER THAN OR EQUAL TO 100 SQ CM EA. ADD 100 SQ CM  C", "code_information": [{"code": "C5274", "type": "HCPCS"}, {"code": "46003851", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 7101.0, "gross_charge": 4282.0, "discounted_cash": 2569.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. LOW COST SKIN SUB. GRAFT TO TRK/ARM/LEG UP TO 100 SQ CM C5272", "code_information": [{"code": "C5272", "type": "HCPCS"}, {"code": "46003819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 7101.0, "gross_charge": 2663.0, "discounted_cash": 1597.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. OF SKIN GRAFT TO TRUNK/ARMS/LEGS AREA UP TO 100SQ CM EA. ADD. 25 SQ CM WOUND SUR. 15272", "code_information": [{"code": "15272", "type": "CPT"}, {"code": "9164424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 2520.0, "discounted_cash": 1512.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. SKIN SUB. GRAFT HEAD/GENITALIA/HND/FT/DIG. UP TO 100SQ CM EA ADD 25SQ CM 15276", "code_information": [{"code": "15276", "type": "CPT"}, {"code": "23179559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 2234.0, "discounted_cash": 1340.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. SKIN SUB. GRAFT TRUNK/ARM/LEG TOTAL WOUND GREATER/EQUAL TO 100SQ CM 1ST 100SQ CM 15273", "code_information": [{"code": "15273", "type": "CPT"}, {"code": "10710867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1673.0, "maximum": 4984.0, "gross_charge": 3899.0, "discounted_cash": 2339.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3268.56, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY FOR RUPTURED APPENDIX 44960", "code_information": [{"code": "44960", "type": "CPT"}, {"code": "1479932", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1988.0, "maximum": 15999.0, "gross_charge": 5570.0, "discounted_cash": 3342.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY INCIDENTAL DURING INTRA-ABDOMINAL SURGERY 44950", "code_information": [{"code": "44950", "type": "CPT"}, {"code": "1479933", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2607.0, "maximum": 6892.72, "gross_charge": 17764.0, "discounted_cash": 10658.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5235.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4959.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6892.72, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY INDICATED DURING INTRA-ABDOMINAL SURGERY 44955", "code_information": [{"code": "44955", "type": "CPT"}, {"code": "1479934", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "gross_charge": 9957.0, "discounted_cash": 5974.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY LAPAROSCOPIC 44970", "code_information": [{"code": "44970", "type": "CPT"}, {"code": "1479935", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5256.83, "maximum": 12028.0, "gross_charge": 27393.0, "discounted_cash": 16435.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11427.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5256.83, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 1988.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", 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{"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 20137.48, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 18123.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES WITH MCC", "code_information": [{"code": "397", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15232.82, "maximum": 29895.51, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15232.82, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 26905.28, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 29895.51, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 26905.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDIX PROCEDURES 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OR RIDGID W/FLOURO W/BRONCHIAL OR ENDOBRONCHIAL BX SINGLE OR MULTI SITES 31625", "code_information": [{"code": "31625", "type": "CPT"}, {"code": "7942280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1546.32, "maximum": 3361.0, "gross_charge": 8079.0, "discounted_cash": 4847.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1546.32, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 1673.0, "maximum": 6235.6, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6235.6, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY RIG/FLEX. W/THERA. ASPIRATION OF TRACHEOBRONCHIAL TREE INITIAL 31645", "code_information": [{"code": "31645", "type": "CPT"}, {"code": "46158219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1546.32, "maximum": 3361.0, "gross_charge": 6627.0, "discounted_cash": 3976.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", 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{"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3411.79, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", 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Essentials HMO", "standard_charge_dollar": 10639.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 7503.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10078.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 7503.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 7503.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8151.38, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 11198.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 7503.47, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 14397.55, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 15997.68, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 14397.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "310", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3247.67, "maximum": 7358.77, "estimated_discounted_cash": 12689.6, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3247.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3247.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5263.96, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5001.04, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3527.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4737.56, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3527.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3527.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3749.55, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5263.96, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3527.13, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6622.73, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7358.77, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6622.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8695.41, "maximum": 20450.2, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 8695.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 8695.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 14093.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 13389.93, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 9443.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 12684.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 9443.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 9443.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 10420.1, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 14093.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 9443.64, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 18404.72, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 20450.2, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 18404.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5369.97, "maximum": 12543.18, "estimated_discounted_cash": 2958.0, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5369.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5369.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 8703.87, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 8269.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 5832.05, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 7833.48, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 5832.05, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 5832.05, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6391.19, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 8703.87, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 5832.05, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 11288.58, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 12543.18, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 11288.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [{"code": "275", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47705.46, "maximum": 93625.39, "estimated_discounted_cash": 161586.46, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 47705.46, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 84260.74, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 93625.39, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 84260.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC OR CAROTID SINUS NEUROSTIMULATOR", "code_information": [{"code": "276", "type": "MS-DRG"}], "standard_charges": [{"minimum": 42107.57, "maximum": 82639.13, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 42107.57, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 74373.36, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 82639.13, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 74373.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [{"code": "277", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32426.53, "maximum": 63639.4, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32426.53, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 57274.02, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 63639.4, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 57274.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 363.0, "maximum": 363.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 363.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH", "code_information": [{"code": "75557", "type": "CPT"}], "standard_charges": [{"minimum": 223.25, "maximum": 1889.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 893.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 893.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 1889.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 1265.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 1700.22, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 1265.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 1265.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 223.25, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 1889.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 1265.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH W/DYE", "code_information": [{"code": "75561", "type": "CPT"}], "standard_charges": [{"minimum": 350.37, "maximum": 1735.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 820.91, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 820.91, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 1735.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 1162.81, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 1561.99, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 1162.81, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 1162.81, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 350.37, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 1735.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 1162.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRAIN", "code_information": [{"code": "C9762", "type": "HCPCS"}], "standard_charges": [{"minimum": 502.61, "maximum": 502.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 502.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRESS", "code_information": [{"code": "C9763", "type": "HCPCS"}], "standard_charges": [{"minimum": 502.61, "maximum": 502.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 502.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI W/STRESS IMG", "code_information": [{"code": "75559", "type": "CPT"}], "standard_charges": [{"minimum": 502.61, "maximum": 2167.14, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1025.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1025.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 2167.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 1451.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 1950.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 1451.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 1451.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 502.61, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 2167.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 1451.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "258", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16799.86, "maximum": 36043.34, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 16799.86, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 16799.86, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 27229.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 25869.84, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 18245.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 24506.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 18245.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 18245.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 18365.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 27229.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 18245.47, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 32438.19, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 36043.34, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 32438.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [{"code": "259", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11749.24, "maximum": 24838.85, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 11749.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 11749.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 19043.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 18092.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 12760.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 17139.29, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 12760.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 12760.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12656.27, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 19043.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 12760.25, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 22354.4, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 24838.85, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 22354.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [{"code": "261", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11258.43, "maximum": 25041.11, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 11258.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 11258.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 18248.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 17336.69, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 12227.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 16423.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 12227.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 12227.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12759.34, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 18248.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 12227.21, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 22536.44, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 25041.11, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 22536.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "260", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20613.75, "maximum": 44115.37, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 20613.75, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 20613.75, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 33411.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 31742.8, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 22387.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 30070.47, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 22387.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 22387.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 22478.34, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 33411.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 22387.54, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 39702.84, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 44115.37, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 39702.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "262", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9879.71, "maximum": 21894.01, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 9879.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 9879.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 16013.44, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15213.61, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10729.84, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14412.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10729.84, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10729.84, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11155.77, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 16013.44, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10729.84, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 19704.11, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 21894.01, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 19704.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 120.39, "maximum": 120.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 120.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 120.39, "maximum": 120.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 120.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 283.33, "maximum": 599.01, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 283.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 283.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 599.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 401.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 539.11, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 401.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 401.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 375.76, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 599.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 401.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "217", "type": "MS-DRG"}], "standard_charges": [{"minimum": 37407.13, "maximum": 84703.05, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 37407.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 37407.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 60631.04, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 57602.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 40625.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 54567.94, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 40625.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 40625.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 43159.21, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 60631.04, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 40625.97, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 76230.83, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 84703.05, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 76230.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "216", "type": "MS-DRG"}], "standard_charges": [{"minimum": 57399.27, "maximum": 129148.43, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 57399.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 57399.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 93035.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 88388.26, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 62338.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 83731.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 62338.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 62338.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 65805.71, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 93035.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 62338.42, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 116230.67, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 129148.43, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 116230.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "218", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34990.82, "maximum": 75805.99, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 34990.82, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 34990.82, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 56714.59, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 53881.83, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 38001.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 51043.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 38001.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 38001.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38625.84, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 56714.59, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 38001.74, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 68223.68, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 75805.99, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 68223.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [{"code": "220", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32023.61, "maximum": 69789.89, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 32023.61, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 32023.61, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 51905.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 49312.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 34779.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 46714.68, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 34779.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 34779.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 35560.43, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 51905.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 34779.2, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 62809.33, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 69789.89, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 62809.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "219", "type": "MS-DRG"}], "standard_charges": [{"minimum": 47891.94, "maximum": 102612.94, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 47891.94, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 47891.94, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 77625.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 73748.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 52012.99, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 69862.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 52012.99, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 52012.99, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 52284.93, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 77625.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 52012.99, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 92349.33, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 102612.94, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 92349.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC", "code_information": [{"code": "221", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27878.59, "maximum": 61858.92, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 27878.59, "methodology": "fee schedule"}, 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"billing_class": "facility"}]}, {"description": "DENTAL INLAY RESIN 3/MRE SUR", "code_information": [{"code": "D2652", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 2 SURF", "code_information": [{"code": "D2542", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 3 SURF", "code_information": [{"code": "D2543", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METL 4/MORE SUR", "code_information": [{"code": "D2544", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 3/MORE SUR", "code_information": [{"code": "D2630", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 4/MORE SUR", "code_information": [{"code": "D2644", "type": "HCPCS"}], "standard_charges": [{"minimum": 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SURFACE", "code_information": [{"code": "D2662", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 3 SURFACE", "code_information": [{"code": "D2663", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 4/MRE SUR", "code_information": [{"code": "D2664", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, 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"facility"}]}, {"description": "HERNIA REPAIR DEVICE 15 X 22 ZENAPRO G23771", "code_information": [{"code": "G23771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 5400.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HERNIA REPAIR DEVICE 20 X 30 ZENAPRO G23770", "code_information": [{"code": "G23770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 16500.0, "discounted_cash": 9900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HERNIA REPAIR DEVICE ZENAPRO 30 X 30 G35114", "code_information": [{"code": "G35114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 19500.0, "discounted_cash": 11700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HERNIA REPAIR DEVICE ZENAPRO G35479", "code_information": [{"code": "G35479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 7200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEROIN METABOLITE", "code_information": [{"code": "80356", "type": "CPT"}], "standard_charges": [{"minimum": 38.58, "maximum": 81.58, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 38.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 81.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 73.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 81.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 54.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 1 AG IF", "code_information": [{"code": "87274", "type": "CPT"}], "standard_charges": [{"minimum": 64.5, "maximum": 136.36, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 64.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 64.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 136.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 91.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 122.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 91.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 91.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 136.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 91.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 2 AG IF", "code_information": [{"code": "87273", "type": "CPT"}], "standard_charges": [{"minimum": 49.6, "maximum": 104.9, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 104.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 70.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 70.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 70.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 104.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 70.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HETASTARCH 6% 500ML BAG", "code_information": [{"code": "MED0477", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 135.57, "discounted_cash": 81.34, "setting": "both", "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY ABSRBJ", "code_information": [{"code": "86310", "type": "CPT"}], "standard_charges": [{"minimum": 49.14, "maximum": 103.92, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 49.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 49.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 103.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 93.53, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 103.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 69.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY TITER", "code_information": [{"code": "86309", "type": "CPT"}], "standard_charges": [{"minimum": 43.16, "maximum": 91.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 91.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 61.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 82.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 61.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 61.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 91.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 61.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 33.43, "maximum": 70.67, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 33.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 33.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 63.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 70.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 47.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA AMP PROBE", "code_information": [{"code": "87532", "type": "CPT"}], "standard_charges": [{"minimum": 234.01, "maximum": 494.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 234.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 234.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 494.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 331.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 445.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 331.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 331.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 494.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 331.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 133.68, "maximum": 282.63, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 133.68, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 282.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 189.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 254.37, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 189.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 189.36, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 282.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 189.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA QUANT", "code_information": [{"code": "87533", "type": "CPT"}], "standard_charges": [{"minimum": 197.78, "maximum": 418.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 197.78, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 197.78, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 418.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 280.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 376.32, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 280.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 280.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 418.13, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 280.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 1464.27, "maximum": 5511.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5235.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4959.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1464.27, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIBICLENS 4 OZ WIDE NECK PACK WITH FOAM DISPENSER", "code_information": [{"code": "57540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.47, "discounted_cash": 11.68, "setting": "both", "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.21, "maximum": 81.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 81.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12446.26, "maximum": 27610.69, "estimated_discounted_cash": 94444.55, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3400.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 12446.26, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 12446.26, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3400.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 20173.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 32.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 19165.81, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 46.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 13517.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 18156.08, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 46.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 13517.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 46.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 13517.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14068.63, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 20173.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 46.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 13517.25, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 24849.0, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 27610.69, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 24849.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17475.67, "maximum": 39241.01, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 17475.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 17475.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 28325.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 26910.52, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 18979.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 25492.77, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 18979.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 18979.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv 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[{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.08, "methodology": "case rate"}], "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": 6.52, "maximum": 6.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.52, "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": 72.67, "maximum": 72.67, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 72.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ BELANTAMAB MAFODOT BLMF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9037", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.73, "maximum": 44.73, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 44.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ BENDAMUSTINE, BAXTER 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9059", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.08, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON IM 1 MCG", "code_information": [{"code": "Q3027", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.9, "maximum": 51.9, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 51.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.16, "maximum": 197.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 197.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CATH PLACE OF DISG/THERA SUBSTANCE EPIDURAL OR SUBARACHNOID LUMBAR/SACRAL PP 64483", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "9975545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 830.42, "maximum": 3361.0, "gross_charge": 3530.0, "discounted_cash": 2118.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "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": 1.19, "maximum": 1.19, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CEFTOLOZANE TAZOBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0695", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.97, "maximum": 6.97, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.97, "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": 15.87, "maximum": 15.87, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 121.77, "maximum": 121.77, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 121.77, "methodology": "case rate"}], "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": 1001.43, "maximum": 1001.43, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1001.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.2, "maximum": 13.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.13, "maximum": 15.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOS DR.REDDY'S 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.7, "maximum": 3.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.68, "maximum": 1.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 222.61, "maximum": 222.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DELANDISTROGENE MOX ROKL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1413", "type": "HCPCS"}], "standard_charges": [{"minimum": 3193324.48, "maximum": 3193324.48, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3193324.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DESMOPRESSIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.0, "maximum": 6.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DIAG/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 2ND LEVEL 64494", "code_information": [{"code": "64494", "type": "CPT"}, {"code": "1582410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 1216.0, "discounted_cash": 729.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVERTEBRAL FACET JOINT W/ IMAGE GUIDANCE LUMBAR/SACRAL 64493", "code_information": [{"code": "64493", "type": "CPT"}, {"code": "1582416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 830.42, "maximum": 3361.0, "gross_charge": 2228.0, "discounted_cash": 1336.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", 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"standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "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": 31.71, "maximum": 31.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 31.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.66, "maximum": 30.66, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 30.66, "methodology": "case rate"}], "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": 26.52, "maximum": 26.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26.52, "methodology": "case rate"}], "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": 34.62, "maximum": 34.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 34.62, "methodology": "case rate"}], "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": 51.42, "maximum": 51.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 51.42, "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": 0.41, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ESTROGEN CONJUGATE 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}], "standard_charges": [{"minimum": 356.06, "maximum": 356.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 356.06, "methodology": "case rate"}], "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": 125.94, "maximum": 125.94, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 125.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.95, "maximum": 0.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.95, "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": 677.32, "maximum": 677.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 677.32, "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": 4.05, "maximum": 4.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4.05, "methodology": "case rate"}], "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": 107.11, "maximum": 107.11, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 107.11, "methodology": "case rate"}], "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": 2588.69, "maximum": 2588.69, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2588.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.24, "maximum": 123.24, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 123.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.15, "maximum": 4.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.35, "maximum": 53.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 53.35, "methodology": "case rate"}], "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": 1.38, "maximum": 1.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.38, "maximum": 17.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.38, "methodology": "case rate"}], "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": 2.34, "maximum": 2.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.34, "methodology": "case rate"}], "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": 2467.15, "maximum": 2467.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2467.15, "methodology": "case rate"}], "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": 60.66, "maximum": 60.66, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 60.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.56, "maximum": 16.56, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.56, "methodology": "case rate"}], "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": 45.76, "maximum": 45.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 45.76, "methodology": "case rate"}], "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": 2.27, "maximum": 2.27, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.69, "maximum": 0.69, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.69, "methodology": "case rate"}], "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, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.05, "methodology": "case rate"}], "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": 191.71, "maximum": 191.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 191.71, "methodology": "case rate"}], "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": 38.23, "maximum": 38.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.23, "methodology": "case rate"}], "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": 2796.7, "maximum": 2796.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2796.7, "methodology": "case rate"}], "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": 160.41, "maximum": 160.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 160.41, "methodology": "case rate"}], "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": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.25, "methodology": "case rate"}], "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": 223.91, "maximum": 223.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 223.91, "methodology": "case rate"}], "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": 601.59, "maximum": 601.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 601.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.16, "maximum": 7.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.58, "maximum": 25.58, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 25.58, "methodology": "case rate"}], "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": 178.81, "maximum": 178.81, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 178.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.88, "maximum": 59.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 59.88, "methodology": "case rate"}], "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": 360.09, "maximum": 360.09, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 360.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONASE ABEPAR-XIOI TREAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3399", "type": "HCPCS"}], "standard_charges": [{"minimum": 2173075.91, "maximum": 2173075.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2173075.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.57, "maximum": 32.57, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.57, "methodology": "case rate"}], "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": 104.95, "maximum": 104.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 104.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 331.57, "maximum": 331.57, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 331.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.8, "maximum": 54.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 54.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.23, "maximum": 9.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.36, "maximum": 1.36, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.52, "maximum": 9.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.89, "maximum": 9.89, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.46, "maximum": 3.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.41, "maximum": 30.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 30.41, "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": 2.02, "maximum": 2.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT NON-ESRD USE", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.18, "maximum": 7.18, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.18, "methodology": "case rate"}], "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": 14.35, "maximum": 14.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14.35, "methodology": "case rate"}], "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": 11.65, "maximum": 11.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.61, "maximum": 35.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 35.61, "methodology": "case rate"}], "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": [{"minimum": 11156.98, "maximum": 11156.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11156.98, "methodology": "case rate"}], "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": 29.21, "maximum": 29.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29.21, "methodology": "case rate"}], "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": 32.42, "maximum": 32.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.42, "methodology": "case rate"}], "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": 21.85, "maximum": 21.85, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.39, "maximum": 19.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.39, "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": 514.87, "maximum": 514.87, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 514.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.91, "maximum": 39.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 39.91, "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": 104.5, "maximum": 104.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 104.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.65, "maximum": 91.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 91.65, "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": 63.88, "maximum": 63.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 63.88, "methodology": "case rate"}], "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": 0.39, "maximum": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.39, "methodology": "case rate"}], "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": 29.41, "maximum": 29.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.74, "maximum": 1.74, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.74, "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": 34.79, "maximum": 34.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 34.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.02, "maximum": 17.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.02, "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": 167.14, "maximum": 167.14, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 167.14, "methodology": "case rate"}], "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": 144.23, "maximum": 144.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 144.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.54, "maximum": 76.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.54, "methodology": "case rate"}], "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": 16.72, "maximum": 16.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.62, "maximum": 29.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29.62, "methodology": "case rate"}], "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": 64.29, "maximum": 64.29, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 64.29, "methodology": "case rate"}], "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": 0.27, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ VELMANASE ALFA-TYCV 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0217", "type": "HCPCS"}], "standard_charges": [{"minimum": 405.43, "maximum": 405.43, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 405.43, "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": 46.46, "maximum": 46.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.46, "methodology": "case rate"}], "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": 5.55, "maximum": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.55, "methodology": "case rate"}], "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, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.06, "methodology": "case rate"}], "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": 36.75, "maximum": 36.75, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 36.75, "methodology": "case rate"}], "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": 5.72, "maximum": 5.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.72, "methodology": "case rate"}], "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": 1.39, "maximum": 1.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.68, "maximum": 8.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.11, "maximum": 19.11, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, APONVIE, 1 MG", "code_information": [{"code": "C9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.8, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ARTESUNATE, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.75, "maximum": 45.75, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 45.75, "methodology": "case rate"}], "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": 48.96, "maximum": 48.96, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 48.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ATEZOLIZUMAB,10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.26, "maximum": 80.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 80.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.53, "maximum": 32.53, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.13, "maximum": 38.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.13, "methodology": "case rate"}], "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, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB FRESENIUSKAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.42, "maximum": 46.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.42, "methodology": "case rate"}], "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": 46.42, "maximum": 46.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, HOSPIRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9049", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.64, "maximum": 1.64, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.64, "methodology": "case rate"}], "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": 311.42, "maximum": 311.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 311.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BUPIVACAINE (POSIMIR)", "code_information": [{"code": "C9144", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.48, "maximum": 0.48, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.48, "methodology": "case rate"}], "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": 0.01, "maximum": 0.01, "estimated_discounted_cash": 48.96, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.01, "methodology": "case rate"}], "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": 21.63, "maximum": 21.63, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21.63, "methodology": "case rate"}], "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, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.05, "methodology": "case rate"}], "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": 4.73, "maximum": 4.73, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, CEFIDEROCOL, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0699", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.08, "maximum": 2.08, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, CIMERLI, 0.1 MG", "code_information": [{"code": "Q5128", "type": "HCPCS"}], "standard_charges": [{"minimum": 244.95, "maximum": 244.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 244.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0737", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.11, "maximum": 2.11, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN PHOSP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0736", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.17, "maximum": 2.17, "estimated_discounted_cash": 98.47, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.17, "methodology": "case rate"}], "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, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, DECITABINE (SUN PHARMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0893", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.03, "maximum": 2.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.03, "methodology": "case rate"}], "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": 222.37, "maximum": 222.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, DUROLANE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7318", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.26, "maximum": 6.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.81, "maximum": 62.81, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 62.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, EPINEPHRINE (BELCHER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.8, "maximum": 1.8, "estimated_discounted_cash": 209.75, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ESMOLOL HCL, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.21, "methodology": "case rate"}], "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": 2.34, "maximum": 2.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.29, "maximum": 171.29, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 171.29, "methodology": "case rate"}], "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": 8.71, "maximum": 8.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.71, "methodology": "case rate"}], "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": 33.89, "maximum": 33.89, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 33.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FOSAPREPITANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1456", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.95, "maximum": 1.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9394", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.05, "maximum": 5.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9393", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.27, "maximum": 20.27, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 20.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FYLNETRA, 0.5 MG", "code_information": [{"code": "Q5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 192.5, "maximum": 192.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 192.5, "methodology": "case rate"}], "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": 5.19, "maximum": 5.19, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, HEMGENIX, PER TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1411", "type": "HCPCS"}], "standard_charges": [{"minimum": 3494311.16, "maximum": 3494311.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3494311.16, "methodology": "case rate"}], "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": 69.77, "maximum": 69.77, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 69.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA HAFYERA/TRINZA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2427", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.65, "maximum": 11.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11.65, "methodology": "case rate"}], "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": 13.65, "maximum": 13.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.65, "methodology": "case rate"}], "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": 1.76, "maximum": 1.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.76, "methodology": "case rate"}], "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": 1.36, "maximum": 1.36, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, LABETALOL HCL, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.16, "maximum": 0.16, "estimated_discounted_cash": 33.04, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, LANREOTIDE, (CIPLA) 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1932", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.1, "maximum": 42.1, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 42.1, "methodology": "case rate"}], "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": 1.28, "maximum": 1.28, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, LENACAPAVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1961", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.05, "maximum": 21.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, LINEZOLID (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2021", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.71, "maximum": 15.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MELPHALAN FLUFENAMI 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 408.2, "maximum": 408.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 408.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MEROPENEM (B. BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2184", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.93, "maximum": 1.93, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, METRONIDAZOLE, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1836", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MICAFUNGIN (PAR PHARM)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2247", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MORPHINE (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.96, "maximum": 6.96, "estimated_discounted_cash": 155.56, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NALOXONE HCL (ZIMHI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2311", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.02, "maximum": 6.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NITROGLYCERIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2305", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.38, "maximum": 1.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NUSINERSEN, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2326", "type": "HCPCS"}], "standard_charges": [{"minimum": 1157.1, "maximum": 1157.1, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1157.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NYVEPRIA", "code_information": [{"code": "Q5122", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.64, "maximum": 62.64, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 62.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, OLICERIDINE 0.1 MG", "code_information": [{"code": "C9101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.25, "maximum": 1.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.25, "methodology": "case rate"}], "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": 3.78, "maximum": 3.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, PANZYGA, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1576", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.1, "maximum": 62.1, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 62.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, PASIREOTIDE LONG ACTING", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2502", "type": "HCPCS"}], "standard_charges": [{"minimum": 442.91, "maximum": 442.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 442.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.34, "maximum": 143.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 143.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, POLATUZUMAB VEDOTIN 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9309", "type": "HCPCS"}], "standard_charges": [{"minimum": 118.6, "maximum": 118.6, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 118.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, RELEUKO 1 MCG", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, REMDESIVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.79, "maximum": 5.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.79, "methodology": "case rate"}], "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": 28.21, "maximum": 28.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 28.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.68, "maximum": 9.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.46, "maximum": 12.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.34, "methodology": "case rate"}], "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": 57.51, "maximum": 57.51, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 57.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, STIMUFEND, 0.5 MG", "code_information": [{"code": "Q5127", "type": "HCPCS"}], "standard_charges": [{"minimum": 329.03, "maximum": 329.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 329.03, "methodology": "case rate"}], "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": 76.85, "maximum": 76.85, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.85, "methodology": "case rate"}], "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": 16.99, "maximum": 16.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.99, "methodology": "case rate"}], "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": 43.03, "maximum": 43.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 43.03, "methodology": "case rate"}], "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": 199.78, "maximum": 199.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 199.78, "methodology": "case rate"}], "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": 129.8, "maximum": 129.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 129.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.1, "maximum": 7.1, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.34, "maximum": 23.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (MYLAN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3371", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.61, "maximum": 5.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3372", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.12, "maximum": 6.12, "estimated_discounted_cash": 326.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VASOPRESSIN, 1 UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.8, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.23, "maximum": 66.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 66.23, "methodology": "case rate"}], "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": 3270.97, "maximum": 3270.97, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3270.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4719.08, "maximum": 4719.08, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4719.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.39, "maximum": 6.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.39, "methodology": "case rate"}], "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": 3217.92, "maximum": 3217.92, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3217.92, "methodology": "case rate"}], "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": 3222.78, "maximum": 3222.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3222.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. AIR / CONTRAST PERITONEAL CAVITY 49400 CL", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "46358996", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 2568.0, "discounted_cash": 1540.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. AIR OR CONTRAST INTO PERITONEAL CAVITY 49400", "code_information": [{"code": "49400", "type": "CPT"}, {"code": "46294621", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 2568.0, "discounted_cash": 1540.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "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": 469.88, "maximum": 469.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 469.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.31, "maximum": 23.31, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.49, "maximum": 8.49, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BONE SUB MAT. INTO SUBCHONDRAL BONE DEFECT W/IMAGE 0707T", "code_information": [{"code": "707T", "type": "CPT"}, {"code": "46020889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2948.97, "maximum": 7101.0, "gross_charge": 12888.0, "discounted_cash": 7732.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2948.97, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 167.39, "maximum": 167.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 167.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.51, "maximum": 5.51, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.51, "methodology": "case rate"}], "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": 14.32, "maximum": 14.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14.32, "methodology": "case rate"}], "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": 17.26, "maximum": 17.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.26, "methodology": "case rate"}], "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": 19.06, "maximum": 19.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. FOR ANTEGRADE NEPHROSTOGRAM/URETEROGRAM; COMPLETE ; EXISTING ACCESS 50431", "code_information": [{"code": "50431", "type": "CPT"}, {"code": "42923550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 622.36, "maximum": 5932.0, "gross_charge": 3363.0, "discounted_cash": 2017.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2806.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2806.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5932.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5635.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 5338.8, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 622.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5932.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FOR ANTEGRADE NEPHROSTOGRAM/URETEROGRAM; COMPLETE ; EXISTING ACCESS 50431 CL", "code_information": [{"code": "50431", "type": "CPT"}, {"code": "46487213", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 622.36, "maximum": 5932.0, "gross_charge": 3363.0, "discounted_cash": 2017.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2806.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2806.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5932.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5635.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 5338.8, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 622.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5932.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3974.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FOR ANTEGRADE NEPHROSTOGRAM/URETEROGRAM; COMPLETE ; NEW ACCESS 50430", "code_information": [{"code": "50430", "type": "CPT"}, {"code": "42923549", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 622.36, "maximum": 12203.0, "gross_charge": 3338.0, "discounted_cash": 2002.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12203.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11593.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10982.7, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 622.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12203.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FOR ANTEGRADE NEPHROSTOGRAM/URETEROGRAM; COMPLETE ; NEW ACCESS 50430 CL", "code_information": [{"code": "50430", "type": "CPT"}, {"code": "46487209", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 622.36, "maximum": 12203.0, "gross_charge": 3338.0, "discounted_cash": 2002.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12203.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11593.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10982.7, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 622.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12203.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FOR URETEROGRAPHY/URETEROPYELOGRAPHY; URETEROSTOMY OR INDEWELLING CATHETER 50684", "code_information": [{"code": "50684", "type": "CPT"}, {"code": "44635698", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 1915.0, "discounted_cash": 1149.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "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": 63.04, "maximum": 63.04, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 63.04, "methodology": "case rate"}], "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": 452.78, "maximum": 452.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 452.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.52, "maximum": 38.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.52, "methodology": "case rate"}], "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": 73.07, "maximum": 73.07, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 73.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.23, "maximum": 2.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.23, "methodology": "case rate"}], "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": 304.17, "maximum": 304.17, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 304.17, "methodology": "case rate"}], "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": 190.79, "maximum": 190.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 190.79, "methodology": "case rate"}], "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": 44.98, "maximum": 44.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 44.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.68, "maximum": 0.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.68, "methodology": "case rate"}], "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": 583.31, "maximum": 583.31, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 583.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.91, "maximum": 0.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.8, "maximum": 3.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.32, "maximum": 60.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 60.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.6, "maximum": 39.6, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 39.6, "methodology": "case rate"}], "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": 10.22, "maximum": 10.22, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 10.22, "methodology": "case rate"}], "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": 312.35, "maximum": 312.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 312.35, "methodology": "case rate"}], "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": 318.8, "maximum": 318.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 318.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.54, "maximum": 2.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.2, "maximum": 56.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 56.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.51, "maximum": 13.51, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.59, "maximum": 1.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.59, "methodology": "case rate"}], "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": 2.95, "maximum": 2.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.23, "maximum": 13.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 158.01, "maximum": 158.01, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 158.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.46, "maximum": 68.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 68.46, "methodology": "case rate"}], "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": 26.37, "maximum": 26.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.82, "maximum": 83.82, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 83.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "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": 348.89, "maximum": 348.89, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 348.89, "methodology": "case rate"}], "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": 48.62, "maximum": 48.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 48.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.06, "maximum": 1.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.15, "maximum": 16.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.35, "maximum": 1.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.35, "methodology": "case rate"}], "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": 1.74, "maximum": 1.74, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.7, "maximum": 67.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 67.7, "methodology": "case rate"}], "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": 71.38, "maximum": 71.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 71.38, "methodology": "case rate"}], "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": 466.19, "maximum": 466.19, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 466.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.91, "maximum": 16.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.91, "methodology": "case rate"}], "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": 22.37, "maximum": 22.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 22.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.99, "maximum": 1.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.59, "maximum": 3.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.59, "methodology": "case rate"}], "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": 94.86, "maximum": 94.86, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 94.86, "methodology": "case rate"}], "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": 11.12, "maximum": 11.12, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.44, "maximum": 3.44, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.44, "methodology": "case rate"}], "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": 212.03, "maximum": 212.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 212.03, "methodology": "case rate"}], "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": 28.35, "maximum": 28.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 28.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.42, "maximum": 75.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 75.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.98, "maximum": 12.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 134.09, "maximum": 134.09, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 134.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.21, "maximum": 12.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.99, "maximum": 7.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TRILURON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7332", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.03, "maximum": 10.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 10.03, "methodology": "case rate"}], "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": 3092.37, "maximum": 3092.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3092.37, "methodology": "case rate"}], "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": 504.0, "maximum": 504.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 504.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.85, "maximum": 19.85, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL 64483", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "1481088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 830.42, "maximum": 3361.0, "gross_charge": 4101.0, "discounted_cash": 2460.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.ANESTHETIC AGENT AND/OR STEROID; LUMBAR/SACRAL EA ADD. 64484", "code_information": [{"code": "64484", "type": "CPT"}, {"code": "1583508", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "gross_charge": 6244.0, "discounted_cash": 3746.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ.DIAG./THERA.AGENT PARAVERTEBRAL FACET JOINT W/IMAGE CERVICAL/THORACIC SINGLE LEVEL 64490", "code_information": [{"code": "64490", "type": "CPT"}, {"code": "1481089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 830.42, "maximum": 3361.0, "gross_charge": 4101.0, "discounted_cash": 2460.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": 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{"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3522.53, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", 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PPM/ICD 33225", "code_information": [{"code": "33225", "type": "CPT"}, {"code": "45340597", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 2607.0, "maximum": 19956.0, "gross_charge": 20330.0, "discounted_cash": 12198.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5235.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4959.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 17960.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 19956.0, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 17960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OR REPLACE PERM. SQ DEFIBRILLATOR W/ELEC/EVAL/INDUCTION PROGRAM/REPROGRAM 33270", "code_information": [{"code": "33270", "type": "CPT"}, {"code": "38612873", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7568.0, "maximum": 54302.0, "gross_charge": 186856.0, "discounted_cash": 112113.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29973.21, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 48872.0, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 54302.0, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 48872.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PACING ELEC. CARDIAC VENOUS LT. VENT. PACING AT TIME OF DEFIB./PACEMAKER 33225", "code_information": [{"code": "33225", "type": "CPT"}, {"code": "40507893", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2607.0, "maximum": 19956.0, "gross_charge": 20330.0, "discounted_cash": 12198.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5235.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4959.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 17960.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 19956.0, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 17960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 1389.42, 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"standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 181.55, "maximum": 3538.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee 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"standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 2587.0, "maximum": 5469.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5196.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3664.0, "methodology": "fee 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{"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4922.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9728.59, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 12541.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 13934.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 12541.0, 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{"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1855.67, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": 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"plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17752.3, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 12541.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 13934.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 12541.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 2587.0, "maximum": 13934.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5196.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4922.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4922.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2848.32, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 3327.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 3697.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 3327.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASK  LARYNGEAL SUP AIRWAY STERILE SZ 3 ALBF030SU", "code_information": [{"code": "ALBF030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.66, "discounted_cash": 19.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK  LARYNGEAL SUP AIRWAY STERILE SZ 4 ALBF040SU", "code_information": [{"code": "ALBF040SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.5, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AF531 MED. FL FACE 4PT HEADGEAR FULL FACE  73-1072622", "code_information": [{"code": "73-1072622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.75, "discounted_cash": 38.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK EZPAP W/MOUTHPIECE & MANOMETER 23-23-0757", "code_information": [{"code": "23-23-0757", "type": "CDM"}], "standard_charges": [{"gross_charge": 144.81, "discounted_cash": 86.89, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE MED C-PAP STAND ELBOW 4 POINT", "code_information": [{"code": "73-1061722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.5, "discounted_cash": 41.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE REG SURG STRL ADLT DISP", "code_information": [{"code": "7210559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.58, "discounted_cash": 44.75, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE T-MAX SUB MPR-DFFM", "code_information": [{"code": "MPR-DFFM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.5, "discounted_cash": 27.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FULL FACE DISPOSABLE LARGE 73-1072623", "code_information": [{"code": "73-1072623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.75, "discounted_cash": 38.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FULL FACE DISPOSABLE SMALL 73-1072621", "code_information": [{"code": "73-1072621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.75, "discounted_cash": 38.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SILICONE SIZE 3", "code_information": [{"code": "M0312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.2, "discounted_cash": 9.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SILICONE SIZE 4", "code_information": [{"code": "M0322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.93, "discounted_cash": 9.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SILICONE SIZE 5", "code_information": [{"code": "M0332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.2, "discounted_cash": 9.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SIZE 2 LMA LMA125020", "code_information": [{"code": "LMA125020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.28, "discounted_cash": 9.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SUP AIRWAY STRL SZ 5 ALBF050SU", "code_information": [{"code": "ALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.5, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 3 CHILD LF ALAA030SU", "code_information": [{"code": "ALAA030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.2, "discounted_cash": 9.72, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SUPREME SZ 5 HUDALBF050SU", "code_information": [{"code": "HUDALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.5, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK MULTI VENT ADULT", "code_information": [{"code": "1088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 6.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NASAL NON-INVASIVE 73-1016692", "code_information": [{"code": "73-1016692", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 48.75, "discounted_cash": 29.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NIV FULL FACE NONVT AAV LRG HCSFFNVAL", "code_information": [{"code": "HCSFFNVAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.31, "discounted_cash": 39.19, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NIV FULL FACE NONVT AAV MED HCSFFNVAM", "code_information": [{"code": "HCSFFNVAM", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.75, "discounted_cash": 38.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NIV FULL FACE NONVT AAV SMALL HCSFFNVAS", "code_information": [{"code": "HCSFFNVAS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.75, "discounted_cash": 38.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN PANORAMIC ADULT 301-0318LT", "code_information": [{"code": "301-0318LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.44, "discounted_cash": 24.86, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYMASK OXYGEN  OT-1025-8", "code_information": [{"code": "OT-1025-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.98, "discounted_cash": 6.59, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK POM ELITE CAPNOGRAPHY SH19698", "code_information": [{"code": "196698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.5, "discounted_cash": 20.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK W/AIRCUSHION INFANT 1278", "code_information": [{"code": "1278", "type": "CDM"}], "standard_charges": [{"gross_charge": 12.45, "discounted_cash": 7.47, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK W/AIRCUSHION LARGE ADULT 1282", "code_information": [{"code": "1282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.68, "discounted_cash": 6.41, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK W/AIRCUSHION YOUTH/SMALL ADULT 1280", "code_information": [{"code": "1280", "type": "CDM"}], "standard_charges": [{"gross_charge": 12.66, "discounted_cash": 7.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MASKBIPAP MASK RESMED REI60602", "code_information": [{"code": "REI60602", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.67, "discounted_cash": 323.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASKSIZE 00 ANESTHESIA EXTRA SMALL NEONATAL DYNJAAMASK9", "code_information": [{"code": "DYNJAAMASK9", "type": "CDM"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 6.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 1988.0, "maximum": 15999.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": 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"CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.5, "discounted_cash": 20.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPE HIP W/ THREE GUIDEWIRES AND 2 ARTHROSCOPY NDLS STRL DISP", "code_information": [{"code": "7209874", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 837.0, "discounted_cash": 502.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BIRTH EMERGENCY 1 BASIN PLACENTA BLUE 1 BLANKET BABY WHT W/ STRIPES 1 CORD", "code_information": [{"code": "DYNJS0600", "type": "CDM"}], "standard_charges": [{"gross_charge": 56.82, "discounted_cash": 34.09, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CARDIAC CATH/ANGIO BSW SUNNYVALE CARDIAC", "code_information": [{"code": "CARDIAC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 406.08, "discounted_cash": 243.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CARDIOVASCULAR SRI BSW SUNNYVALE CARDIO", "code_information": [{"code": "CARDIO", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1888.47, "discounted_cash": 1133.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATH LAB BSW SUNNYVALE DYNJ10117C", "code_information": [{"code": "DYNJ10117C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.07, "discounted_cash": 286.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATH LAB DYNJ10117F", "code_information": [{"code": "DYNJ10117F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 307.38, "discounted_cash": 184.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATH LAB SRI BSW SUNNYVALE CATH", "code_information": [{"code": "CATH", "type": "CDM"}, {"code": "272", "type": "RC"}], 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MX210", "code_information": [{"code": "MX210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.99, "discounted_cash": 20.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GENERAL SURGERY BSW SUNNYVALE DYNJ10121B", "code_information": [{"code": "DYNJ10121B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.75, "discounted_cash": 89.85, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GYN SRI BSW SUNNYVALE GYN", "code_information": [{"code": "GYN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1112.73, "discounted_cash": 667.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HEAD & NECK BSW SUNNYVALE ENT", "code_information": [{"code": "ENT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 868.44, "discounted_cash": 521.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HEMOCONTRATOR SORIN 020-117-801", "code_information": [{"code": "20-117-801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK KNEE ARTHROSCOPY BSW SUNNYVALE DYNJ10122B", "code_information": [{"code": "DYNJ10122B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.33, "discounted_cash": 108.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPAROSCOPY  DYNJ10123C", "code_information": [{"code": "DYNJ10123C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.54, "discounted_cash": 102.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPAROTOMY MAJOR W/ ONE BEDSIDE PAPER BAG ONE BASIN ONE BASIN RING ONE BLAD", "code_information": [{"code": "DYNJS0301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.79, "discounted_cash": 93.47, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAVH DYNJ10124C", "code_information": [{"code": "DYNJ10124C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.47, "discounted_cash": 108.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAVH PACK BSW SUNNYVALE DYNJ10124A", "code_information": [{"code": "DYNJ10124A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.24, "discounted_cash": 115.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MODIFIED WRIGHT'S STAIN HEMA-TEK 10310965", "code_information": [{"code": "10310965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.59, "discounted_cash": 121.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MODIFIED WRIGHT-GIEMSA STAIN STAT STAIN 32OZ 10314755", "code_information": [{"code": "10314755", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.59, "discounted_cash": 121.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MORPHIX STERILE PROCEDURE 3.5 MM", "code_information": [{"code": "100-10-035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK NOVASURE CO2 CARTRIDGE", "code_information": [{"code": "815012US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OPEN HEART BSW SUNNYVALE DYNJ902757B", "code_information": [{"code": "DYNJ902757B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1985.04, "discounted_cash": 1191.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ORTHO HAND & FOOT BSW SUNNYVALE DYNJ10125C", "code_information": [{"code": "DYNJ10125C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.65, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PACEMAKER BSW SUNNYVALE DYNJ10126B", "code_information": [{"code": "DYNJ10126B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.25, "discounted_cash": 82.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PERI GYN  DYNJ10127B", "code_information": [{"code": "DYNJ10127B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.84, "discounted_cash": 92.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PODIATRY SRI BSW SUNNYVALE PODIATRY", "code_information": [{"code": "PODIATRY", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 913.68, "discounted_cash": 548.21, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROC MINOR SNGL BASIN TRAY I BASIC CORE ONE BASIN ONE BASIN RING 2 BLADES N", "code_information": [{"code": "DYNJS0106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.01, "discounted_cash": 138.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE STERILE DYNACLIP UNIVERSAL", "code_information": [{"code": "3000-01-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 513.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK QUATTO PROCEDURE 3000-13-000", "code_information": [{"code": "3000-13-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER ARTHROSCOPY BSW SUNNYVALE DYNJ10128B", "code_information": [{"code": "DYNJ10128B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 242.64, "discounted_cash": 145.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SINUS 12MM BARON", "code_information": [{"code": "400407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.5, "discounted_cash": 24.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SPECIALS BSW SUNNYVALE", "code_information": [{"code": "DYNJ10216B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.33, "discounted_cash": 126.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SPECIALS BSW SUNNYVALE DYNJ10216A", "code_information": [{"code": "DYNJ10216A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 1481.0, "maximum": 12028.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11427.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 1988.0, "maximum": 12028.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11427.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC. TRANS. MECH. THROMB. ART W/PHARM. THROMB. INJ W/FLUORO INT 37184 CL", "code_information": [{"code": "37184", "type": "CPT"}, {"code": "46448615", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 5689.0, "maximum": 15975.63, "gross_charge": 16325.0, "discounted_cash": 9795.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11427.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15975.63, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC. TRANS. MECH. THROMB. VEINS W/PHARM. THROMB. INJ W/FLUORO ADD 37185 CL", "code_information": [{"code": "37185", "type": "CPT"}, {"code": "46448616", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 3538.0, "gross_charge": 8193.0, "discounted_cash": 4915.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC. TRANSCATH CLOSURE PARAVALVULAR LEAK INT. OCC. DEV. 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[{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3793.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3793.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 7619.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 7218.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5256.83, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 952.55, "maximum": 952.55, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 952.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23644.6, "maximum": 51857.38, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 23644.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 23644.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 38324.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 36409.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 25679.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 34491.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 25679.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 25679.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26423.17, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 38324.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 25679.19, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 46670.47, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 51857.38, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 46670.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19794.17, "maximum": 43125.33, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 19794.17, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 19794.17, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 32083.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 30480.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 21497.44, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 28874.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 21497.44, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 21497.44, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21973.88, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 32083.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 21497.44, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 38811.82, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 43125.33, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 38811.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES", "code_information": [{"code": "321", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19491.58, "maximum": 38253.63, "estimated_discounted_cash": 95566.98, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19491.58, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 34427.41, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 38253.63, "methodology": "case 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"standard_charge_dollar": 15483.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 15483.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15939.34, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 23108.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 15483.66, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 28153.18, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 31282.1, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 28153.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", 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"360", "type": "RC"}], "standard_charges": [{"minimum": 4486.0, "maximum": 15999.0, "gross_charge": 18980.0, "discounted_cash": 11388.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee 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"type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1673.0, "maximum": 3697.0, "gross_charge": 7937.0, "discounted_cash": 4762.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, 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LUMBAR 22514", "code_information": [{"code": "22514", "type": "CPT"}, {"code": "1481590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6517.82, "maximum": 15999.0, "gross_charge": 12221.0, "discounted_cash": 7332.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6517.82, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUG. INCL. CAVITY CREATION MECH. DEVICE 1 VERT.UNI OR BIL. THORACIC 22513", "code_information": [{"code": "22513", "type": "CPT"}, {"code": "1481592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6517.82, "maximum": 15999.0, "gross_charge": 12221.0, "discounted_cash": 7332.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6517.82, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR MULTIPLE 22515", "code_information": [{"code": "22515", "type": "CPT"}, {"code": "1481591", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "gross_charge": 9909.0, "discounted_cash": 5945.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY (INCLUDING BIOPSY) 1 LUMBAR BODY 22511", "code_information": [{"code": "22511", "type": "CPT"}, {"code": "1481593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2948.97, "maximum": 15999.0, "gross_charge": 7573.0, "discounted_cash": 4543.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2948.97, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY (INCLUDING BIOPSY) 1 THORACIC BODY 22510", "code_information": [{"code": "22510", "type": "CPT"}, {"code": "1481594", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2948.97, "maximum": 15999.0, "gross_charge": 7573.0, "discounted_cash": 4543.8, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2948.97, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 4984.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 4486.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS VERTEBROPLASTY EACH ADDITIONAL BODY 22512", "code_information": [{"code": "22512", "type": "CPT"}, {"code": "1481595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "gross_charge": 6194.0, "discounted_cash": 3716.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"minimum": 1988.0, "maximum": 2209.0, "setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"minimum": 1988.0, "maximum": 2209.0, "setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 3359.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS INCLUDING IMAGING  33016", "code_information": [{"code": "33016", "type": "CPT"}, {"code": "45577568", "type": "CDM"}, {"code": "481", "type": "RC"}], "standard_charges": [{"minimum": 1459.1, "maximum": 3538.0, "gross_charge": 5609.0, "discounted_cash": 3365.4, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1673.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3184.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1459.1, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3538.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2370.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORAL EVALUATION", "code_information": [{"code": "D0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.43, "maximum": 120.43, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 120.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL MAINT PROCEDURES", "code_information": [{"code": "D4910", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING & ROOT", "code_information": [{"code": "D4341", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING 1-3TEETH", "code_information": [{"code": "D4342", "type": "HCPCS"}], "standard_charges": [{"minimum": 802.16, "maximum": 802.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 802.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6075.24, "maximum": 14198.57, "estimated_discounted_cash": 54035.3, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 6075.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 6075.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 9847.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 9355.17, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 6598.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 8862.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 6598.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 6598.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7234.67, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 9847.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 6598.01, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 12778.39, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 14198.57, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 12778.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9061.9, "maximum": 20974.49, "estimated_discounted_cash": 41086.7, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 9061.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 9061.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 14687.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 13954.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 9841.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 13219.11, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 9841.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 9841.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 10687.25, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 14687.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 9841.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 18876.57, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 20974.49, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 18876.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4219.85, "maximum": 9445.31, "estimated_discounted_cash": 43121.22, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 4219.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 4219.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 6839.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6498.08, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4582.96, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6155.74, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4582.96, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4582.96, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4812.72, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 6839.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4582.96, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 8500.56, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 9445.31, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 8500.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 55.73, "maximum": 55.73, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 55.73, "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": 13776.09, "maximum": 29683.92, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 13776.09, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 13776.09, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 22328.86, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 21213.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 14961.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 20095.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 14961.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 14961.5, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15125.01, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 22328.86, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 14961.5, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 26714.86, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 29683.92, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 26714.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "40", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22321.25, "maximum": 51238.6, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 22321.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 22321.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 36179.22, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 34372.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 24241.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 32561.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 24241.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 24241.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26107.89, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 36179.22, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 24241.97, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 46113.59, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 51238.6, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 46113.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "42", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10898.43, "maximum": 23151.52, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 10898.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 10898.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 17664.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 16782.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 11836.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 15898.17, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 11836.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 11836.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11796.52, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 17664.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 11836.23, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 20835.84, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 23151.52, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 20835.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERISTRIP 60MM PSD6006-ECH-V", "code_information": [{"code": "PSD6006-ECH-V", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 559.5, "discounted_cash": 335.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12532.28, "maximum": 28015.23, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 12532.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 12532.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 20312.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 19298.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 13610.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 18281.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 13610.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 13610.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14274.75, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 20312.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 13610.67, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 25213.07, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 28015.23, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 25213.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21704.95, "maximum": 47572.53, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 21704.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 21704.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 35180.29, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 33423.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 23572.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 31662.26, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 23572.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 23572.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 24239.89, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 35180.29, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 23572.64, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 42814.2, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 47572.53, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 42814.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9282.85, "maximum": 19912.59, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 9282.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 9282.85, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15046.03, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 14294.51, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10081.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 13541.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10081.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10081.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 10146.17, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15046.03, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10081.62, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 17920.89, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 19912.59, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 17920.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"minimum": 825.87, "maximum": 6891.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6546.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6201.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 825.87, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERM FLP TUBE OCCLS W/IMPLT", "code_information": [{"code": "567T", "type": "CPT"}], "standard_charges": [{"minimum": 1988.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMACATH INSERT. 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81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Arterial Draw", "code_information": [{"code": "36600", "type": "CPT"}, {"code": "45600650", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 3361.0, "gross_charge": 121.0, "discounted_cash": 72.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee 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Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Chest Percussions", "code_information": [{"code": "94667", "type": "CPT"}, {"code": "2699699", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 116.38, "gross_charge": 162.76, "discounted_cash": 97.66, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 116.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Chest Percussions subsequent", "code_information": [{"code": "94668", "type": "CPT"}, {"code": "2699698", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 116.38, "gross_charge": 156.51, "discounted_cash": 93.91, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", 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"standard_charge_dollar": 116.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Each additional treatment (for this date of service) for pre", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "2699693", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Evaluation and Education", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "2699692", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 158.24, "discounted_cash": 94.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Evaluation of patient using neb/MDI", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "2699691", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 158.24, "discounted_cash": 94.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Oxygen per 24 hours", "code_information": [{"code": "2699686", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Pressurized Non-Pressurized Inhalation Treatment", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "2699685", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Vent assist and management", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "2699681", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2497.96, "discounted_cash": 1498.78, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Vent assist and management subsequent days", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "2699680", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2086.56, "discounted_cash": 1251.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Ventilation management each additional day", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "2699679", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2086.56, "discounted_cash": 1251.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Ventilator per 24 hours", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "2699677", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2086.56, "discounted_cash": 1251.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges - RT -> Ventillator initiation", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "2699676", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2497.96, "discounted_cash": 1498.78, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Arterial Draw", "code_information": [{"code": "36600", "type": "CPT"}, {"code": "45339806", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 3361.0, "gross_charge": 121.0, "discounted_cash": 72.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 116.38, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> CPAP/BIPAP per 24 hours", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "45339801", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 1325.59, "discounted_cash": 795.35, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> CPR", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "45339800", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 285.96, "maximum": 1645.0, "gross_charge": 1149.92, "discounted_cash": 689.95, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 285.96, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Chest Physiotherapy Initial", "code_information": [{"code": "94667", "type": "CPT"}, {"code": "45339804", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 116.38, "gross_charge": 162.76, "discounted_cash": 97.66, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 116.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Chest Physiotherapy Subsequent", "code_information": [{"code": "94668", "type": "CPT"}, {"code": "45339803", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 116.38, "gross_charge": 156.51, "discounted_cash": 93.91, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 116.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Continuous Pulse Ox Monitoring", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "45339802", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 142.31, "maximum": 142.31, "gross_charge": 671.6, "discounted_cash": 402.96, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 142.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> EEG", "code_information": [{"code": "95816", "type": "CPT"}, {"code": "45339799", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 285.96, "maximum": 285.96, "gross_charge": 1225.95, "discounted_cash": 735.57, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 285.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> IPPB initial", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45339793", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> IPPB subsequent", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45339792", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Inhalation Treatment Initial", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45344002", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Inhalation treatment Subsequent", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45339796", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Initial continuous inhalation treatment", "code_information": [{"code": "94644", "type": "CPT"}, {"code": "45344003", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 116.38, "maximum": 116.38, "gross_charge": 272.76, "discounted_cash": 163.66, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 116.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Intubation", "code_information": [{"code": "31500", "type": "CPT"}, {"code": "45339794", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 222.54, "maximum": 7101.0, "gross_charge": 953.96, "discounted_cash": 572.38, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.54, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> MDI initial", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45339791", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> MDI subsequent", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45339790", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 135.06, "discounted_cash": 81.04, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Nasotracheal suctioning", "code_information": [{"code": "31720", "type": "CPT"}, {"code": "45339789", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 3361.0, "gross_charge": 346.66, "discounted_cash": 208.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Oxygen per 24 hours", "code_information": [{"code": "45339788", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RT Charges SV -> PFT w/ Bronchodilator", "code_information": [{"code": "94060", "type": "CPT"}, {"code": "45339786", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 285.96, "maximum": 285.96, "gross_charge": 691.36, "discounted_cash": 414.82, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 285.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> PFT w/o Bronchodilator", "code_information": [{"code": "94010", "type": "CPT"}, {"code": "45339785", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 142.31, "maximum": 142.31, "gross_charge": 371.26, "discounted_cash": 222.76, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 142.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Sputum Collection", "code_information": [{"code": "89220", "type": "CPT"}, {"code": "45339781", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 46.02, "maximum": 155.61, "gross_charge": 100.31, "discounted_cash": 60.19, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 46.02, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 65.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 87.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 65.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 65.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 155.61, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 65.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Sputum induction w/ inhalation treatment", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "45344005", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 194.32, "maximum": 194.32, "gross_charge": 139.11, "discounted_cash": 83.47, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 194.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Vent assist and management subsequent days", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "45339775", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2086.56, "discounted_cash": 1251.94, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RT Charges SV -> Ventilator initial Set up (one time charge)", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "45339773", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 570.93, "maximum": 570.93, "gross_charge": 2497.96, "discounted_cash": 1498.78, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 570.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AG IF", "code_information": [{"code": "87283", "type": "CPT"}], "standard_charges": [{"minimum": 79.97, "maximum": 169.07, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RXT BREAST APPL PLACE/REMOV", "code_information": [{"code": "C9726", "type": "HCPCS"}], "standard_charges": [{"minimum": 1481.0, "maximum": 1645.0, "setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Radiology Diagnostic Angiocardiography", "code_information": [{"code": "321", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Radiology Therapeutic And/Of Chemotherapy Administration Radiation Therapy", "code_information": [{"code": "333", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "UHC", "plan_name": "Charter", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UHC", "plan_name": "Nexus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 63.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Arteriography", "code_information": [{"code": "323", "type": 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W/DISCECTOMY SECOND LEVEL CERVICAL  22858", "code_information": [{"code": "22858", "type": "CPT"}, {"code": "38612871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1481.0, "maximum": 15999.0, "gross_charge": 14765.0, "discounted_cash": 8859.0, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY CERVICAL ANTERIOR APPROACH; SINGLE INTERSPACE 22856", "code_information": 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{"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16978.66, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12203.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8176.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": 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"plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 1988.0, "maximum": 6891.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6546.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6201.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1988.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2209.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", 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"fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 2473.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER ALL POLY SZ48     870-GK48 870-GK48", "code_information": [{"code": "870-GK48", "type": "CDM"}, {"code": "278", "type": "RC"}], 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"standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16978.66, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 12541.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 13934.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 12541.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL T4", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "1233840", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 43.48, "maximum": 91.91, "gross_charge": 287.0, "discounted_cash": 172.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 61.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 82.72, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 61.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 61.58, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 91.91, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 61.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL THYROID LOBECTOMY WITH CONTRALATERAL SUBTOTAL LOBECTOMY 60225", "code_information": [{"code": "60225", "type": "CPT"}, {"code": "1482258", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3793.0, "maximum": 8020.0, "gross_charge": 19876.0, "discounted_cash": 11925.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3793.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3793.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 8020.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 7619.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 7218.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 5373.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5256.83, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 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"plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5256.83, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 7701.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 6931.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 26.55, "maximum": 56.14, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 26.55, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 26.55, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue 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"methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 408.29, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 303.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 303.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 453.65, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 303.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [{"code": "278", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30243.25, "maximum": 59354.54, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 30243.25, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 53417.75, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 59354.54, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 53417.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [{"code": "279", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21701.31, "maximum": 42590.38, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21701.31, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 38330.39, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 42590.38, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 38330.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [{"code": "173", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20849.69, "maximum": 40919.03, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 20849.69, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 36826.2, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 40919.03, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 36826.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND SUPPORT & SERVICE FUSION BIOPSY  FB2000", "code_information": [{"code": "FB2000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRATOME XL SHORT NOSE M00535900", "code_information": [{"code": "M00535900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 214.2, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRAVIOLET LIGHT THERAPY", "code_information": [{"code": "96900", "type": "CPT"}], "standard_charges": [{"minimum": 36.54, "maximum": 36.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 36.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ARTERY ECHO", "code_information": [{"code": "76820", "type": "CPT"}], "standard_charges": [{"minimum": 100.16, "maximum": 557.33, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 263.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 263.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 557.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 373.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 373.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 373.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 100.16, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 557.33, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 373.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 292.27, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 292.27, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8013.12, "maximum": 18605.85, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 8013.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 8013.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12988.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 12339.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8702.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 11689.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8702.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8702.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9480.34, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12988.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8702.64, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 16744.84, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 18605.85, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 16744.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5312.23, "maximum": 11652.94, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5312.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5312.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 8610.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 8180.22, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 5769.34, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 7749.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 5769.34, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 5769.34, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5937.59, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 8610.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 5769.34, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 10487.38, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 11652.94, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 10487.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNICLIP NOTCHED 20MM 213820ND 213820ND", "code_information": [{"code": "213820ND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1569.0, "discounted_cash": 941.4, "setting": "both", "billing_class": "facility"}]}, {"description": "UNILOANER RENTAL XSP-SPEC-RENTAL", "code_information": [{"code": "XSP-SPEC-RENTAL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 27.13, "maximum": 27.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 27.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 27.13, "maximum": 27.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 27.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CARDIOVASCULAR SERVICE 93799", "code_information": [{"code": "93799", "type": "CPT"}, {"code": "45365073", "type": "CDM"}, {"code": "489", "type": "RC"}], "standard_charges": [{"minimum": 142.31, "maximum": 1645.0, "gross_charge": 832.0, "discounted_cash": 499.2, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 142.31, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMOTHERAPY PX", "code_information": [{"code": "96549", "type": "CPT"}], "standard_charges": [{"minimum": 43.28, "maximum": 43.28, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 43.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 222.54, "maximum": 12028.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 5689.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 11427.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.54, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 8059.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED CT PROCEDURE", "code_information": [{"code": "76497", "type": "CPT"}], "standard_charges": [{"minimum": 82.79, "maximum": 82.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 82.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 375.76, "maximum": 375.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 375.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 49.37, "maximum": 49.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 49.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 49.37, "maximum": 49.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 49.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX GI PROCEDURE", "code_information": [{"code": "91299", "type": "CPT"}], "standard_charges": [{"minimum": 142.31, "maximum": 1645.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 142.31, "methodology": "case rate"}, {"payer_name": "UHC", "plan_name": "Charter", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Commercial", "standard_charge_dollar": 1645.0, "methodology": "fee schedule"}, {"payer_name": "UHC", "plan_name": "Nexus", "standard_charge_dollar": 1481.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 375.76, "maximum": 375.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 375.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 181.55, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", 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